The Biden-Harris Administration is reducing health care costs, expanding access to coverage, and ensuring nearly everyone who buys their own individual or family health insurance through a Marketplace can receive a tax credit to reduce their premiums. 

The American Rescue Plan (ARP) not only provides the resources for America to beat this pandemic, but it also expands access to health insurance coverage, lowers costs, and ensures that health care truly is a right for all Americans.

It’s Working: After the Biden-Harris Administration made available a Special Enrollment Period through the Federal Marketplace from February 15 to May 15 for people who needed health care coverage during the pandemic, more than 200,000 people signed up for Marketplace coverage through HealthCare.gov in the first two weeks – a three-fold year over year increase. Now following the passage of the ARP more than 14.9 million Americans who currently lack health insurance and many current enrollees will receive additional financial support to find the coverage that best meets their needs at a price they can afford.

• More Affordable Options are Available: Many people who enroll in health coverage through HealthCare.gov will qualify to save money on their premiums. Premiums after advance payment of these increased tax credits will decrease, on average, by $50 per person per month and $85 per policy per month. Four out of five enrollees (up from 69% pre-ARP) will be able to find a plan for $10 or less per month after tax credits, and over 50% (up from 14% pre-ARP) will be able to find a Silver plan for $10 or less per month.
• Making it Easier for Consumers: Starting on April 1, consumers will be able to take advantage of increased premium tax credits on high quality health care plans when they enroll in coverage through HealthCare.gov. Every day, we’re working to make the consumer experience even better, streamlining HealthCare.gov and providing the help and support consumers want in order to understand their options and pick the right plan for their families.

The American Rescue Plan:

Reduces the cost of health care coverage for 9 million consumers currently receiving financial assistance by ensuring consumers eligible for premium tax credits have at least a couple plans to choose from that won’t cost more than 8.5% of their household income on their Marketplace plan premium per year.

• Many premiums will decrease, on average, by $50 per person per month and $85 per policy per month.
• Four out of five enrollees (up from 69% pre-ARP) will be able find a plan for $10 or less per month after tax credits, and over 50% (up from 14% pre-ARP) will be able to find a Silver plan for $10 or less per month.
• 1 out of 4 enrollees on Heathcare.gov will be able to upgrade to a higher plan category that offers better out of pocket costs at the same or lower premium compared to what they’re paying today (excludes enrollees already at the highest health plan category available, including certain enrollees eligible for cost sharing reductions).
• For example:
  • Uninsured couples earning over $70,000 could save more than$1,000 per month on their monthly premium.
  • A family of four making $90,000 will see their premiums decrease by $200 per month.
  • An individual making $19,000 will be able to find health insurance coverage with no monthly premium, saving roughly $66 per month on average.

Expands the number of people eligible to save money on their health care coverage.

About 14.9 million Americans who currently lack health insurance will be able to save money on their premiums to find the coverage they need at a price they can afford:

• 3.6 million uninsured people are estimated to be newly eligible for health care coverage savings.(See state level data in table 1)
• 1.8 million uninsured people are estimated to be eligible for zero-dollar benchmark Marketplace coverage, since PTC-eligible individuals with incomes below 150% of the FPL will now qualify for a 100% premium subsidy for the benchmark Marketplace plan. (See state level data in table 1.)  Millions more are eligible for zero-dollar coverage for non-benchmark plans.
• An additional 9.5 million uninsured people with incomes between 150% and 400% of the FPL are estimated to potentially qualify for additional financial support to reduce out-of-pocket costs for Marketplace premiums.

Addresses racial health inequities by expanding coverage and reducing costs. Increased affordability and health insurance coverage expansion will allow historically uninsured communities – especially those who have faced significant health disparities – to access coverage, thereby improving opportunities for health care during and beyond the COVID-19 pandemic.

• The COVID-19 pandemic has exacerbated stark health disparities among certain racial and ethnic minority populations in several areas, including infections, hospitalizations, death rates, and vaccination rates.  Many of these same populations have experienced job loss or loss of health insurance coverage at disproportionally high rates.
  • 48,000 uninsured American Indians and Alaska Natives will be newly eligible to save money on health care coverage and 21,000 will be eligible for zero-dollar benchmark Marketplace plans.
  • 730,000 uninsured Latinos will be newly eligible to save money on health care coverage and 580,000 will be eligible for zero-dollar benchmark Marketplace plans.
  • 360,000 uninsured Black and African Americans will be newly eligible to save money on health care coverage and328,000 will be eligible for zero-dollar benchmark Marketplace plans.
  • 197,000 uninsured Asian, Native-Hawaiian and Pacific Islander will be newly eligible to save money on health care coverage, and 50,000 will be eligible for zero-dollar benchmark Marketplace plans.
• The Biden-Harris administration is further expanding access to health insurance coverage and improving access to mental health services and community-based programs that address social determinants of health. 

This article was originally published on hhs.gov on May 12, 2021.
Written by: HHS Press Office

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The $1.9 trillion coronavirus relief bill under consideration by the House after passage by the Senate would increase subsidies to people who buy Affordable Care Act health plans, marking the biggest changes to the health law since its passage in 2010.

The subsidy changes would be temporary and expire after two years, but would mean much lower payments for almost 14 million people now insured on the individual market. The package also includes funding aimed at enticing states that didn’t expand their Medicaid programs earlier to do so now, and subsidies to cover the cost of health insurance for people who lose their jobs.

Currently under the ACA, people who earn 400% of the federal poverty level aren’t eligible for the tax credits, also known as subsidies, that help offset the cost of buying health plans. That means a single person who earns more than about $51,000 isn’t eligible, nor is a family of three that makes about $87,000.

The legislation would eliminate an income cap that limits who is eligible for ACA tax credits to reduce monthly insurance premiums. It would also limit the amount households pay to only 8.5% of their income on healthcare, and it would boost subsidies to lower-income consumers.

With the increased subsidies, costs would come down for many who buy ACA-compliant plans. For a 60-year-old with a $55,000 income, premiums would drop by around 50% to 80% depending on the plan, according to a Kaiser Family Foundation analysis.

The subsidy boost for the ACA plans has been a long-held goal of Democrats who say expanding the tax credits would allow more people to benefit from the coverage.

Democrats have praised the subsidy expansion as a way to improve upon the ACA by ending its so-called subsidy cliff, saying it will benefit low- and middle-income families, and reduce health-insurance expenses for lower-income people. They are expected to press to make it permanent during the 2022 midterm elections.

“Affordable, accessible health coverage is a necessity in a pandemic,” said Rep. Richard Neal (D., Mass.)

Republicans and some conservative advocacy groups oppose the plan, saying the federal government will spend billions of dollars to help insure a relatively low number of people who aren’t financially needy. They also call it a handout to insurance companies who stand to profit as more people purchase ACA plans.

“This liberal dream is a billions of dollars giveaway to health insurance companies and encourages more employers to drop their job-based plans altogether,” said Republican Sen. Steve Daines of Montana.

Critics of the plan add that the need for expanded subsidies shows the ACA has made insurance too expensive.

The expanded tax credits would increase federal deficits by about $34 billion over 10 years, according to a February analysis by the Congressional Budget Office. The initiative would expand health insurance through the exchanges by 1.7 million people in 2022.

Older adults with incomes above 400% of poverty would generally see some of the most significant savings, according to the Kaiser Family Foundation. The additional subsidies in the Covid relief bill could yield substantially lower premium payments for the nearly 14 million people insured on the individual market.

The changes, which mark the first major expansion of the 2010 Affordable Care Act, were part of the healthcare agenda Mr. Biden laid out in his campaign.

The hospital industry and insurers support the move. “[The] legislation includes many provisions to help hospitals and health systems provide care to their patients and communities,” Rick Pollack, president and chief executive of the American Hospital Association, said last week. While the hospitals support the changes, he said, they are disappointed the package doesn’t deliver more funding for provider relief.

The relief package also would encourage states to expand Medicaid. The federal government would for two years increase its matching funds to cover both existing Medicaid enrollees and the full cost of expanding, up from its current payment covering 90% of costs for states that haven’t expanded yet. Twelve states including Florida, Texas and Wisconsin have opted not to expand Medicaid, and state officials have in many cases cited the cost as a reason. It isn’t clear whether the change would persuade those states to expand Medicaid.

The Senate version also provides more relief for people who have lost their jobs and need health insurance. People who lose their jobs can remain on their employers’ health plans for up to 18 months but must pay a monthly premium. The Senate bill would subsidize all of the premiums, a boost from a House-passed bill that would subsidize 85% of the premium costs.

The subsidies for Cobra—an insurance-continuation program that employers are, in most circumstances, required to offer workers who have been terminated—have been cheered by insurers and some labor groups who say it will ensure people retain coverage during a pandemic that has led to a surge in joblessness claims.

“Covid-19 has left many hospitality workers in a desperate situation: no job, no healthcare, no savings,” said D. Taylor, international president of Unite Here, a labor union in the hotel, food service, laundry, warehouse and casino gaming industries.

With the Senate passing its version of the relief package, Democrats are already in talks about what healthcare measures to include in the next legislative package. Measures such as lowering the age eligibility of Medicare from 65 to 60 are likely to face fiercer objections from hospitals and other companies that could see their profits erode.

This article was originally published on wsj.com on March 9, 2021.
Written by: Stephanie Armour

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You May Be Surprised by the Type of American Who Is Postponing Basic Health Care During the Pandemic.

There’s more than one way to get sick during the COVID-19 pandemic. You can contract the virus, of course, as more than 28 million Americans already have. Or you can dodge the disease but still suffer from the disruption caused by quarantines and social distancing, if they lead you to neglect routine health care. That, a new TIME-Harris Poll survey shows, is just what too many of us are doing.

The top-line numbers from the survey of 1,093 participants (a representative sample of the U.S. public) are sobering, with 78% of respondents reporting that they have put off at least some medical services during the past three months of pandemic. Of those procedures, dental exams or cleanings were the most frequently missed, with 30% saying that they have passed on regular oral care. Annual physical check-ups were next at 27%, followed by eye exams at 25%.

More troubling—if somewhat less common—were the 15% of people who said they were missing appointments with specialists, including orthopedists, dermatologists and, most worrisome, cardiologists. The 500,000 Americans who have died of COVID-19 since the start of the pandemic represents a scary enough figure, but it still trails the 655,000 who lose their lives each year to cardiovascular disease. If even a fraction of heart-disease patients are missing their regular cardiology visits during the pandemic, there could be a bump in that overall mortality number down the line.

A similar trend could result from people missing routine cancer screenings. “I am most concerned about an increase in morbidity and mortality due to cases of cancer being detected too late,” says Kelly Anderson, a health services researcher and PhD candidate at John Hopkins University’s Bloomberg School of Public Health.

Demographics play a significant role in who is staying current with health care during the pandemic and who is letting things slide. In the case of education, for example, good health practices seemed to be inversely associated with academic achievement. Only 16% of people with a high school education or less have put off their routine check-ups during the pandemic, compared to 31% of people with some college and 34% of college graduates.

Similarly, lower income Americans appear to be doing a better job of looking after themselves than higher-earners. Just 21% of people in households with less than $50,000 annual income are missing routine physicals, compared to 23% in the $75,000 to $100,000 group and a whopping 35% of those in households earning more than $100,000 annually.

In some ways, these numbers are unsurprising. Lower-income and less-educated people tend to be more likely to have chronic health problems and thus have less of an option of skipping their physicals. “Conditions like diabetes and hypertension are more common among people with lower income. They might feel like they just know they can’t miss a check-up, so they make it more of a priority,” says Dr. Jessica Justman, an infectious disease specialist and epidemiologist at Columbia University’s Mailman School of Public Health. “People with higher income have more options for diet and exercise and are healthier overall.”

Insurance—or lack of it—may be at work too, says Dr. David Buchholz, medical director of primary care at Columbia University Irving Medical Center. People in lower income brackets are disproportionately represented among the uninsured, and thus likelier to lack access to health care to begin with; if they haven’t been getting regular physicals all along, they’d be less likely to describe themselves as missing them now. “If they’re starting from a baseline health care of zero,” Buchholz says, “they’ll still be zero during the pandemic.”

For people who do have health insurance, the type of policy is a factor as well. Among those who get their insurance through the public marketplace—where there can often be high deductibles and other out of pocket expenses—62% are saying no thanks to annual checkups compared to just 32% of people on employer-sponsored health care plans.

As with so many things, race and ethnicity play a significant role as well, with communities of color suffering more—often lacking health insurance and working in lower income jobs. Among white Americans, 20% report missing their annual check-ups during the pandemic, compared to 29% of Black Americans and 48% of Hispanic Americans. Structural disadvantages that made health care harder to access pre-pandemic would only be exacerbated when lockdowns and economic hardship set in.

Anderson also points out that even among low-income Medicaid recipients, there are up-front costs for health care, which may simply not be affordable in the COVID-19 economy. “Even small out of pocket costs can be a major barrier and lead to people forego care,” she says.

No surprise at all in our incorrigibly partisan culture, political leanings have played a role in health care decisions in the past year. Throughout the pandemic, blue-staters and Democrats have generally been more compliant with mask-wearing and social-distancing, while red America has pushed back, as one study from the University of Chicago confirmed. But when it comes to health checkups, self-identified liberals were likelier to report letting things slide in the TIME/Harris Poll survey, with 32% saying they’ve skipped annual exams, compared to 27% of moderates and 24% of conservatives.

Buchholz thinks at least some of this may have to do with the share of red-staters who believe the pandemic is either a hoax or exaggerated. If they’re continuing to go to bars and restaurants and parties, there’s no reason they wouldn’t go right ahead going in for physicals too. Liberals, by contrast, who tend to fear the pandemic more, might see doctors’ offices as dangerous congregate settings and seek to avoid them. “In red states, people are going about their business,” Buchholz says. “Liberals are hunkering down more.”

This article was originally published on time.com on February 23, 2021.
Written by: Jeffrey Kluger